Healthcare Provider Details

I. General information

NPI: 1164737896
Provider Name (Legal Business Name): STACEY APPLE ROSS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7640 HIGHWAY 70 S SUITE 210
NASHVILLE TN
37221-1758
US

IV. Provider business mailing address

PO BOX 681478
FRANKLIN TN
37068-1478
US

V. Phone/Fax

Practice location:
  • Phone: 615-673-1420
  • Fax: 615-673-1421
Mailing address:
  • Phone: 615-591-6590
  • Fax: 615-591-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8752
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: